ED Coding and Reimbursement Alert

Question: A 33-year-old patient reports to the ED with a badly injured left arm. The ED physician reduces the patient's (closed) dislocated left elbow, and then splints a fracture of the left humerus, and refers the  patient to an orthopedist for follow up and further treatment for the humerus fracture. Can we code separately for the dislocation, splint, and fracture treatment?

Missouri Subscriber

Answer: You should be able to submit a code for the elbow dislocation treatment - and maybe for the splinting of the humerus fracture. On the claim, report 24600 (Treatment of closed elbow dislocation; without anesthesia) for the elbow treatment

You might be able to include 29105 (Application of long arm splint [shoulder to hand]) with modifier 59 (Distinct procedural service) for the splint application - if the payer allows you to code for it. A lot of payers will  bundle this code into 24600 in this scenario, so check with your payer if you are unsure of its policy.

Also: This sounds like a painful injury, and the physician may have provided or ordered moderate sedation for the procedures. If the notes indicate moderate sedation, consider including a code for it on the claim.

If, for example, notes indicate the physician oversees 25 minutes of moderate sedation during the procedures, report 99144 (Moderate sedation services [other than those services described by codes 00100-01999], provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time) for the sedation.

Why not 24605? The 24605 (... requiring anesthesia) might be tempting, but this code is not for moderate sedation services. CPT is referring to deep sedation, such as might happen in the OR, in 24605.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky,MD, CPC, FACEP, president of MRSI, an ED coding and billing company inWoburn, Mass.